Pox_ An American History - Michael Willrich [29]
On November 14, a white Middlesboro physician named Dr. F. P. Kenyon examined Scott. He found the miner lying ill in a building in Over the Rhine. Located across the tracks and the lazy Yellow Creek from the heart of Middlesboro, the section was notorious for its rowdy saloons and bawdy houses where whites and blacks mixed. The building where Scott lay had once housed John Hughes’s saloon, remembered locally, in the words of a white newspaperman, as “the scene of many a bloody coon scrap.” Dr. Kenyon recognized Scott’s condition, but just to make sure he called in a second physician, who confirmed his diagnosis: a “well developed case of smallpox.”20
That simple act of naming Scott’s condition brought the miner and the physicians into the orbit of the law. A Kentucky statute required all physicians and heads of household to report any contagious and infectious diseases to their local board of health. In most communities in this predominantly rural state, “local” meant the county. But under state law, a city of Middlesboro’s size (more than 2,500 residents) was supposed to have a board of health and a health officer of its own. Middlesboro had no hospital in 1898, let alone a functioning board of health. But two of the three members of the Bell County Board of Health, Dr. T. H. Curd and Dr. L. L. Robertson, lived in the city, and they, too, confirmed the diagnosis, estimating that roughly fifteen people had come into contact with Scott. That night, residents clustered in the streets to discuss the rumored outbreak, the latest insult in a long run of bad luck. Some said it was time to leave Middlesboro for good. Meeting in an emergency session, the city council ordered the police to enforce a quarantine against the Over the Rhine district. Priding itself on its healthy mountain air, Middlesboro had no pesthouse. Scott and several African American residents known to have been exposed to him were placed under guard in the old Hughes saloon.21
Politically, the city council’s strategy for thwarting a smallpox epidemic had two things going for it: it didn’t inconvenience the white citizenry much, and it was cheap. Kentucky law held local governments liable for the cost of managing an epidemic. In a legal case arising from the Bardstown smallpox outbreak of 1883, a Kentucky court noted that this obligation went further than “the ordinary social duty to care for the helpless.” “If the poor man is neglected he may starve or freeze, but the calamity is personal, and his grave hides it; but if, having an infectious disease, which poisons the air, he is left where he lies, the entire community is menaced.” Whether this fiscal responsibility properly fell on Middlesboro, Bell County, or both would become a heated issue. For now, the city council decided that local police, already on the payroll, would enforce the quarantine. A more aggressive approach—a targeted quarantine and a well-run pesthouse coupled with compulsory vaccination of the entire population—would have been much more expensive. A pesthouse cost money: fees for the physician, wages for the guards, and food for the indigent patients. A general vaccination order posed other problems.22
Vaccination was not popular in Kentucky. Although state board of health rules required that public schoolchildren submit to vaccination, the board estimated that at least one third of the state’s white residents and a larger part of its African Americans had never been vaccinated. In Middlesboro, according to one estimate, nine tenths of the population had never undergone the procedure. And when a local government ordered a general vaccination, it was liable under state law for the cost of providing vaccination free to the poor. In a place as impoverished as Middlesboro, that meant paying a lot of doctor’s fees and buying a lot of vaccine.23
Another factor weighed into the political calculus. A good many Middlesboro residents, including the editors of the local newspapers, greeted the news of a smallpox outbreak with skepticism. The Weekly Herald described Scott’s illness